The elimination of open defecation and its adverse health
effects: a moral imperative for governments and
development professionals

Duncan Mara

ABSTRACT
In 2015 there were 965 million people in the world forced to practise open defecation (OD). The
adverse health effects of OD are many: acute effects include infectious intestinal diseases, including
diarrheal diseases which are exacerbated by poor water supplies, sanitation and hygiene; adverse
pregnancy outcomes; and life-threatening violence against women and girls. Chronic effects include
soil-transmitted helminthiases, increased anaemia, giardiasis, environmental enteropathy and smallintestine
bacterial overgrowth, and stunting and long-term impaired cognition. If OD elimination by
2030 is to be accelerated, then a clear understanding is needed of what prevents and what drives the
transition from OD to using a latrine. Sanitation marketing, behaviour change communication, and
‘enhanced’ community-led total sanitation (‘CLTS þ ’), supplemented by ‘nudging’, are the three most
likely joint strategies to enable communities, both rural and periurban, to become completely
OD-free and remain so. It will be a major Sanitation Challenge to achieve the elimination of OD by
2030, but helping the poorest currently plagued by OD and its serious adverse health effects should
be our principal task as we seek to achieve the sanitation target of the Sustainable Development
Goals – indeed it is a moral imperative for all governments and development professionals.

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Re: Ending open defecation by 2030? - The elimination of open defecation and its adverse health effects (paper by Duncan Mara)

Thanks a lot for posting about your paper here, giving us the opportunity to discuss this and to correspond directly with the author which is super!

It's a really important topic: "The elimination of open defecation and its adverse health effects: a moral imperative for governments and development professionals"

I looked at the chapter on "Adverse health effects of open defecation" and my question is: are the mentioned figures specific to open defecation, or rather in general due to "lack of sanitation"? I assume the latter. It is really hard to pin down the exact causes of diarrhea and helminthiasis, i.e. whether it was contact with feces in the environment or lack of handwashing at critical times. So am I right to assume that you didn't try to specify the figures particularly for open defecation but used published data in general, which would include e.g. also people having access to unimproved sanitation facilities like pit latrines without a slab.

More key statements could probably be extracted from your paper and added to these Wikipedia articles. Do you have any suggestions, e.g. perhaps key findings that are not so well known yet? Or, when you look at what is already written there in those two Wikipedia articles, which existing content could be substantiated or improved by adding your paper as a reference?

I hope you agree with me that these Wikipedia articles have the potential to play an important role in providing information to the general public. The one on sanitation gets nearly 1000 views per day on average. The one on open defecation gets about 600 views per day.

Regards,
Elisabeth

P.S. Is there any chance this paper could be made into an open access paper? (I assume perhaps the cost was prohibitive? Not sure if IWA can make an exception if someone from SuSanA secretariat asks nicely; we've had success with that in the past)